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DisclaimerThis webinar may be recorded. This webinar presents a sampling of best practices and overviews, generalities, and some laws. This should not be used as legal advice. Itentive recognizes that there is not a “one size fits
all” solution for the ideas expressed in this webinar; we invite you to follow up directly with us for more personalized information as it pertains
to your specific practice and issues.
Thank you, and enjoy the webinar.
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Our passion is to provide solutions for our healthcare provider partners which help them improve patient care, enhance the patient experience and maintain a financially healthy practice.
Since 2003 we have specialized in NextGen®
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An Introduction to the
New & Improved NextGen Care
Guidelines
Introductions
Cindi Kincade
Vice President, Consulting Solutions
Lindsey Lanning
Healthcare Informatics Coordinator
An Introduction to the
New & Improved NextGen Care
Guidelines
Today’s Webinar
• Introduction to the Care Guidelines
Enhancement Overview
Template Basics
• Paged View Care Guidelines Template
• Grid View Care Guidelines Template
• Activate Clinical Guidelines Template
• Care Guidelines Set-Up Template
Care Guidelines’ Templates
New Care Guidelines Enhancements
• New paged guideline management panel
• New Setup template that contains a built-in FAQ
• Client-requested changes:
Practices can have guidelines automatically applied if a patient meets certain age, gender, and diagnosis criteria
Changes to the guideline definition are automatically made for each patient when guidelines are refreshed
Guidelines will pull from the Lab Module
Able to create individual reminders, which are patient-level
• Does not require 8.3.11
Quality Reporting Benefits
Care Guidelines are the easiest way for many clients to track and document numerous clinical quality measures, which are required for Meaningful Use attestation, PCMH certification, ACO agreements, and many more.
• Examples include quality reporting on health maintenance, such as mammograms and flu shots, and reporting on delivery of chronic condition care, such as A1C lab tests and eye exams for patients with diabetes.
Templates
• There are two types of pop-up templates available with the new care guidelines:
Grid View Template
(New) Paged View Template
• These templates are used to handle health maintenance and disease management functions
• These templates are available from all specialty template sets
Template Views
Grid View
Paged View
Paged View Template Panels
• The following panels are found on the Care Guidelines Paged View template:
Clinical Guidelines
Recent Orders
Metrics
Immunizations
• When Care Guidelines opens for the first time, you will see the paged view with clinical guidelines panel expanded
Grid View Template Panels
The following panels are found on the Care Guidelines Grid View template:
• Clinical Guidelines
• Recent Orders
• Metrics
• Immunizations
• Vital Signs
• Nutrition
• Drug Therapy
• Screening Questions
Care Guideline Items Due
When a patient has Care Guideline items due the active text link will display a red box with a number in it. This number represents the total number of items required for that patient and takes into account any duplicates for more than one active guideline.
Care Guidelines Being Followed
• The user can see the guidelines that are actively being followed for a patient in the left blue panel
• Each guidelines listed on this blue panel has a red box which shows the number of items that are due or recommended, but have not been completed yet
Any item that does not meet the status of “due” or “not prescribed” is not included in this count
Care Guidelines Paged View Template
Paged View Template
Activate new or update current active clinical guidelines for the patient as appropriate
Review, place orders, and update the status of guideline items, as appropriate
Review and manage recent orders
Review immunizations and track metrics
CQM check
Launch the Care Guidelines Grid View template, which provides access to additional information that providers may find helpful
• This is where activities for following a disease/condition and/or health maintenance during a patient encounter are performed
• This includes:
Paged View Template Features
• There are now only four panels which supports more streamlined navigation and includes Clinical Guidelines, Recent Orders, Immunizations, and Metrics with the default view being the expanded Paged View Clinical Guidelines panel
• A new “I” info button which explains “How to use this template” and launches a PDF document complete with information and screenshots
• Numerous filtering options using the show checkboxes at the top
Paged View Template Features• The ability to view up to
eight guideline items/Recommended Care items per page with arrows to go between pages
• Check boxes next to each orderable item so the user can select up to eight items and order all at one time
• The ability to easily see the interval, start, and stop ages for an Orderable item under each item as a blue active text link
• The ability to click on an Orderable item and view the Guideline that includes the test
Paged View Template Features• The ability to easily see what is due for the patient as all
due items will have a due date of today in red font with a yellow exclamation mark
• A status field to easily change the status of an item to completed, performed elsewhere, excluded, declines, due, or hold testing as well as a last completed field to quickly update the last completed date if needed
• A new comments field for each orderable test or Recommended Care item that accommodates 100 characters of free text and carries forward until manually removed by a user
• The ability to sort each column (Guideline, Next Due, Status, and Last Completed) by clicking on the column header
• The ability to create a “Personalized Guideline” by adding a single orderable test or tests without having to apply an entire Guideline to a patient’s chart
• The ability to add free text Personalized Reminders with due dates and the ability to task to a workgroup
Clinical Guidelines
• What is a guideline?
A set of items related to health maintenance or a disease condition to be followed for a patient
• What is a guideline item?
Individual things that make up a set, and as a set they are referred to as a “guideline” or “clinical guideline”
• The Clinical Guidelines Panel is where guideline items associated with chronic conditions or health maintenance are managed. This is where the majority of activities are performed.
Clinical Guidelines (Paged View)
When the Clinical Guidelines panel is on the Care Guidelines Paged View template, you can:
• Launch the Activate Clinical Guidelines pop-up template to active clinical guidelines, document/update risk indicators
• Modify individual active guideline items at the patient level
• See what clinical guideline(s) an individual item is part of
• Add an individual orderable item to follow for the patient using the Personalized Orderables functionality without having to apply the entire Guideline
• Add reminders for yourself using the Reminders functionality
Clinical Guidelines (Paged View)
Information Displayed
To work effectively with the Clinical Guidelines panel on the care Guidelines Paged View template, it is helpful to know what information is displayed and what functionality is available.
• Patient Guidelines section in the left blue pane lists all clinical guidelines that are currently being followed for the patient (Also called “active guidelines”)
• Red boxes next to each active guideline listed displays the number of items for that guideline that are due
• Orderable items have a check box next to it. This check box must be selected to place an order for the item. The Place Order button remains disabled until you have selected a check box
• Recommended Care items do not have a check box. Instead, they have Goals
Information Displayed
The Add Orderable active text link allows you to add an
orderable item to the list using the Personalized
Orderables functionality
The Add/Update Reminders active text link allows you to
add or update a personal reminder to yourself about the
patient using the Reminders functionality
The Measure Status section on the left blue panel shows
you whether you have met the criteria for meeting a
clinical quality measure that you are tracking
The CQM Check button launches the CQM Check utility
that allows you to check and update the status of the
measures that are listed in the Measure Status section,
and update with any status details
Clinical Guidelines (Paged View)
• On the Clinical Guidelines panel:
Shows every item that is part of an active guideline
Up to 8 guideline items display on a page
The navigation toolbar lets you easily view the different pages displaying active guideline items
• For active guidelines, items are displayed in the following order:
Active guideline items that are due, in alphabetical order
Items for active guidelines that are not yet due until a date in the future
Items for active guidelines that have been declined (due date will still display)
Items for active guidelines that have been “excluded” (next due date will be blank)
Clinical Guidelines (Paged View)Workflow on this panel includes 2 different types of tasks:
• Tasks you perform at every encounter with the patient:
Reviewing and updating status and goals
Placing orders for testing
Tasks you perform initially and later to only update with changes:
• Documenting risk indicators
• Activating a guideline
• Tasks that you perform on occasion:
Removing a guideline or guideline item
Re-applying a guideline in order to bring back a guideline item that has been removed
Workflow Summary (Paged View)For the Clinical Guidelines Panel:
• Activate guideline(s) for the patient. (Performed at the beginning)
• Document or update risk indicators for health maintenance
Risk Indicators Health Maintenance link can be found:
• Care Guidelines Grid View template, on the Clinical Guidelines panel
• Activate Clinical Guidelines template, on the Active Guidelines panel
• Review and update the status for items listed on the Clinical Guidelines panel
• Review clinical guidelines for orderable items that are due, such as exams, labs and diagnostic studies
Activating a Clinical Guideline
To activate a clinical guideline:
1. On the Clinical Guidelines panel, click the Add/Update button. The Activate Clinical Guidelines pop-up template launches
2. On the Activate Guidelines panel, click in the Condition field and select from the pick list
3. If you select any other guidelines, you must also select a diagnosis that is to be associated with that guideline
4. The selected diagnosis code displays in the Code field
5. Click Add. The clinical guideline is now active for the patient, and guideline items display
6. Click Save & Close to return to the Care Guidelines Paged View template
Activating a Clinical Guideline
Personalized Reminders
• This functionality allows you to create and track reminders to yourself related to the patient
• You can create a Personalized Reminder for anything that you wish to be reminded of within the patient’s chart
• Tasking allows you to send a reminder to your Inbox
• Reminders are tracked in the Care Guidelines system, and display in the left blue panel under Patient’s guidelines
Recent Orders Panel• This is where you can view and
follow orders for the patient
• The Recent Orders panel grid is a viewable grid only – no actions can be taken for items displayed in the grid from the grid itself
• The Recent Orders panel grid displays completed orders or pending orders depending on which of the tabs above the grid you select
Pending – displays any orders that have not been canceled, deleted, or completed
Completed – displays orders for the patient that have been completed
• The user can use the lab/radiology orders processing link or add standing orders and task by selecting the corresponding links
Recent Orders PanelOn either tab, the user can click:
• ‘Edit’ to launch the order management template where results can be documented and orders completed
• ‘Add’ which will launch the My Plan template where protocol orders that are due can be viewed and ordered by clicking the protocol radial button and specifying a time frame in the protocols due in field
Immunizations Panel
• This is where a provider can view a record of immunizations orders for a patient, including status, date ordered, sequence number, and date completed
• The Immunizations data grid is view-only
• All immunizations must be ordered and managed from the Immunizations module
• Orders for Immunizations are not displayed in the Recent Orders Panel
Metrics Panel (Paged View)• This is where a provider can view metrics for a patient, lab and
vital sign values, for up to 10 rows of data
• When you first open the Care Guidelines Paged View template and expand the Metrics panel, it appears blank
• Flow sheets do not display until you select a guideline listed in the blue left side bar under Patient’s guidelines
• Note that a guideline must have metrics configured in order to have flow sheets display. Choices of categories for metrics include: Audiometry, Lab Test, Vision Screening, and Vital Signs
• Data is displayed in a flow sheet format
• The Metrics data grid is view-only
Care Guidelines Grid View Template
Grid View
• Displays only those items that are due for the patient
• Offers basic functionality for activating and tracking guidelines for the patient
• Provides access to additional information that providers may find helpful
Switching from Paged View to Grid View
You can choose to open the original Grid View template by clicking the Grid View active text on the paged view clinical guidelines panel
Panels We Already Covered
• Recent Orders
• Immunization
• Metrics
Screening Questions Panel• This is where you can view and document patient responses
to screening questions related to a condition or disease
• When you first open the Care Guidelines Grid View template and expand the Screening Questions panel, it appears blank
• Questions do not display until you select a guideline listed in the blue left side bar under Outstanding Guidelines
• Note that a guideline must have screening questions configured in order to have screening questions display. Not all guidelines have screening questions configured
Vital Signs Panel
• This is where a provider can view vital signs documented during this encounter
• Previously entered vital signs can also be edited or removed, and new vital signs can be entered
• The Vital Signs panel is also found on other office visit templates
Nutrition PanelThis is where a provider can enter information about the patient’s diet and nutritional supplements, review the patient’s BMI value, which is calculated on the Vital Signs template, and document that the patient was counseled about their dietary habits
Drug Therapy Panel• This is where a provider can review and enter information about medications that have been prescribed for the patient and discontinued
• Medications displayed in the Drug Therapy panel grid are those medications for the patient found in the Medication module
• Medications displayed in the grid can be filtered by medication class
Clinical Guidelines Panel (Grid View)
The Clinical Guidelines panel on the Care Guidelines Grid View template displays active guidelines that are due for the patient in a data grid
• To see the details for a clinical guideline item, highlight the row in the grid
• Details for the guideline items display in the field found above the grid
Clinical Guidelines Panel (Grid View)
Workflow Summary (Grid View)
For the Clinical Guidelines panel…
1. Activate guideline(s) for the patient. (Performed once at the beginning.)
2. Document or update risk indicators for health maintenance
3. Review and update the status for items in the grid using the fields above the Clinical Guidelines panel grid
4. Review clinical guidelines for items that are due, such as labs and diagnostic studies. The Status displays “due” and orders can be placed from the Clinical Guidelines panel data grid
Review Status
• Guideline items that do not display the status “due” in the grid are recommended care, and are not addressed at a specific time interval. These listed items serve as a reminder
• To update the status for guideline items:
1. Highlight the item in the grid
2. Select the status
3. Click Update/Close
Placing Order from Grid
• Protocol items require orders and typically have a specific time frame attached
• To place orders for protocol items:
1. Highlight the item in the grid
2. Click Order
Activate Clinical Guidelines Template
Activate Clinical Guidelines Template• The Add/Update button on the Clinical Guidelines panel
opens the Activate Clinical Guidelines template where you activate or restore guidelines
• Tasks carried out on this template include:
Removing a clinical guideline or guideline item
Bringing back a removed clinical guideline or guideline item
Viewing clinical references for guideline items
Adding a diagnosis from the patient’s problem list to the patient’s ICD billing list
Reviewing clinical guideline history for the patient
• Activating a clinical guideline is performed initially, usually only once. The guideline must be activated before it can be followed the patient.
Activating a Guideline• Clinical guidelines for health maintenance or a disease
condition that you want to follow for a patient must first be activated before you can use the Care Guidelines system with the patient
• Guidelines are activated on the Active Guidelines panel of the Activate Clinical Guidelines template
• Activating a clinical guideline is performed initially, usually only once
• If you attempt to activate a guideline that has already been activated, you will be asked if you would like to re-apply the guideline
• “Re-applying a guideline” can be done if certain items within the guideline are not being followed, and now you wish to add them so that you can follow them
Remove/Restore Guidelines• Guidelines that have been activated for a patient by
mistake can only be removed in the same encounter in which they were activated
The time to remove an entire or any individual guideline item is before you have started using it. Once you have data attached to the guideline or guideline item, you will not be able to remove it.
• A guideline item that has been removed can be restored by re-applying the guideline that activated it for the patient (This means activating the guideline again)
• When you re-apply a guideline, the system will go through all of the existing items that are active, and will only re-apply the one that is missing from the set for the condition
Remove/Restore Guidelines• The Remove/Restore Guidelines panel on the Activate Clinical
Guideline pop-up template is where you can remove individual guideline items or an entire clinical guideline by disease condition
• If you change your mind, you can restore guidelines that have been removed
• You can remove an individual guideline item that will not be followed while the remaining items for the guideline are followed for the patient
Reviewing Clinical Guidelines History
• A history of clinical guideline tests or exams can be reviewed on the Clinical Guidelines History template
• This is where you can see all guideline items that are completed and no longer due
• This template can be launched from three places:
Clinical Guidelines panel on the Care Guidelines Paged View template
Clinical Guidelines panel on the Care Guidelines Grid View template
Active Guidelines panel on the Activate Clinical Guidelines template
Clinical Guidelines History
Accessing Web-Based References
In the Activate Clinical Guidelines Template you can highlight an item in the grid and click the ‘Web” button in order to access the corresponding web-based clinical reference.
Care Guidelines Set-Up Template
BenefitsA new consolidated Care Guidelines Set-up template has been created to ensure that the set-up and maintenance of Care Guidelines is an easier process. Features of the new template include:
• Four panels arranged in the order needed to either set up custom Guidelines or maintain/alter out-of- the-box Guidelines
• Active text links to quickly access the following practice templates that might be used in conjunction with Care Guidelines: Medication Classes, Diagnosis Groups/Reference Systems, and Recommended Care
• An easy view of the File Maintenance Mappings for the tests that are currently mapped in the Order NextGen Healthcare Test Compendium table
• The ability to copy Care Guidelines Set-up to other practices or opt out (at the practice level) of Recommended Care – meds and Recommended Care – non-meds
• The ability to create or modify existing Guideline Conditions and Reasons
• The ability to set Guideline Conditions/Reasons to auto-apply based on parameters defined by the practice, such as Interval, Start, and Stop ages
• The ability to easily associate a number of items to either an out-of-the-box or custom-created Guideline Conditions/Reasons
Care Guidelines Set-Up
• Four Panels
Define Guideline Reasons & Auto Application
Orderable Tests Setup
Test Equivalents and Alternatives
FAQs
• Active text links to access guideline related system/practice templates
Medication Classes
Diagnosis Groups Management
Recommended Care
• Ability to:
Copy Care Guidelines set up to other practices.
Opt out (at the practice level) of Recommended Care —meds.
Opt out of Recommended Care — non meds.
Define Guideline Reasons & Auto Application
• Create new or modify existing Guideline Conditions/ Reasons
• Checkbox allows you to set Guideline Conditions/ Reasons to auto apply
Orderable Tests Setup
Ability to easily associate new tests, instructions, exams, office medications, office procedures, office labs, immunizations to either an out of the box or custom created Guideline Conditions/Reason
Test Equivalents and Alternatives• Ability to easily associate Test Descriptions and/or Test codes that are
an exact match to a Test name (Test Equivalents)
• Ability to easily associate Test Descriptions and/or Test codes that are not an exact match to a Test name but are an alternative test that the practice feels would also satisfy the test (Test Alternatives)
• Easy view of the File Maintenance Mappings for the tests that are currently mapped in the Order NextGenTest Compendium table
• The ability to verify during set up if a Test Equivalent or Test Alternative Code has a valid SIM code
FAQS• Most commonly
asked questions/ answers regarding set up and use of Care Guidelines
• Printable PDF document attached with additional information
• Helpful screen shots
Items to Consider• There is a warning in the install guide that when you auto-
apply 5 or more care guideline conditions in the system template there may be an impact on performance
• When you auto-apply a guideline it applies patient by patient and does not apply until you go into the patient and open either SOAP or Intake
• The user now has the ability to order labs, tests, and more right from the care guidelines template which sends them to the order module for processing
This requires NextGen Compendium mapping to all labs which the care guidelines tests may be ordered from
This will also require someone to open the Lab/Radiology Order Processing template after the order is placed in care guidelines, select the vendor and push the order to the Orders Module
Client ExperienceCurrently, we have a few clients who have implemented this and have started training, and while there have been some challenges, overall providers really like it.
There is a list of 16 known issues associated with this release of Care Guidelines, so practices should check this list to see if they are affected.
Several examples of these issues are:
• Known issue KI91707 – The Metrics panel does not refresh on the paged view, only on the grid view.
• Known issue KI96073 – comments entered on the paged view don’t print on documents
• Known issue KI96105 – recommended items marked as “counseled” do not appear in the master IM doc
• Known Issue KI96076 - Reminders do print on documents
Care Guidelines Wrap-Up
• Many Quality Reporting Initiatives are supported by this release
• Care Guidelines Paged View Overview
4 panels
Info button
Numerous filtering options
8 items per page
• Care Guidelines Set-Up Template Overview
4 panels
Arranged in the order needed
Can set up custom Guidelines
Maintain/alter out of the box Guidelines
Order multiple tests
Easily see when a test is due
Personalized reminders
Recommended care
Care Guidelines Resources
• In the NextGen Success Community there is a Care Guidelines 1.0 Overview Article where all of this information can be found and it contains:
Executive Summary
Release Notes
Setup Guide
User Guide
Various White Papers
• Ngkbm Recommended Care
• Ngkbm Medication Classes
• Ngkbm Data Sets
• Ngkbm Common Dx Framework
• Restore and Clear
Uncertain Where Your Practice Stands?
Let Itentive help:
• By assessing your current readiness
• Providing recommendations
• Implementation of new processes and procedures
Next Steps
• Visit us Itentive.com
• Sign-up for our informative webinars and blog
• Consider our 3-day, fixed price on-site consultations:
Clinical Workflow
Revenue Cycle and Front Office
Technology and Performance
• Test Drive our Products
Questions
• Lindsey Lanning
Healthcare Informatics Coordinator
224-220-5621
• Cindi Kincade
Vice President, Client Solutions
224-220-5575
Thank you
